Mail: what is mental disorder?

In this post on my book blog: a reader asks these questions:I gave her my ignorant layman’s answer, but if you guys can offer a more learned answer for me to pass on to her, all the better, particularly because you are Christians who don’t buy into the “all sin is a mental disorder” mentality.

This was the question, and Elspeth’s answer.

[Question]

How do we define ‘mental illness’? Is this a postmodern word? I guess what I’m trying to articulate is, what do we mean when we say, “mental illness”?

-is it something you are born with, like an anomaly
-is it something that happens to you, as in a response to something that was done to you
-is it something can be healed, as in an “illness” of the flu or a “broken” leg

[Answer]

You asked, “How do we define ‘mental illness’? As I am not a doctor, I will make it business to ask a doctor and get more learned answer.

Ignorant layman’s answer:

When a person is clearly and unambiguously disconnected from reality, I would argue that a mental illness is present. I know there is an argument to be made for the presence of demonic possession, and I am not at all dismissing that, but having known a couple True believers who were afflicted with mental illness, I am not one who automatically jumps to that conclusion. Demonic “oppression”? I don’t know.

Given the rapid increase in the numbers of such people over the last generation or so, and yes I have done extensive research because of concern for a loved one, I would also submit that there are environmental factors at play. Food, water, contaminants, hormones, lifestyle changes that take away naturally occurring hormonal balances such as exercise- all of this make it easier I believe for people to slip into depression, bipolar, etc. There have even been studies that have shown that girls who lose their mothers during a particular age window (9-12, pre puberty) are at increased risk of having some hormonal wiring go awry and show up post puberty relating to bipolar disorder.

I don’t think people are born with it. I do believe it can be triggered by events that happen to you at a pivotal time of life, whether the thing was done to you or was a thing beyond human control. I do believe that in many cases, it can be healed or greatly improved. I don’t believe that current traditional medical approaches to mental health take environmental and lifestyle factors into the equation enough. They automatically assume, that if medication alone isn’t working that the patient is either not taking it right, or need a higher dose.

I think people who have blind faith in traditional medical approaches suffer longer.

And absolutely, I believe that a strong Christian life and faith, environmental controls, and sometimes meds, coupled with good self- care (not a good phrase I know but it’s all I have at this early hour), one can be healed enough to live a productive, balanced life.

Now, the reality is that we have an entire culture which -quite literally breeds the kind of behavior that our grandparents might have considered evidence of a person being a little “off”.

It is unfortunate that when people realize something if a little “off” with themselves, they are often encouraged to find someone to blame for their issues rather than take a hard look internally.

Conversely, to touch on OKRickety’s point, people are far too inclined to want to find a way to put people’s behavior into a neat little box that they can check off as an excuse not to do their duty to love for better or worse.

Think about it. If you can write your mate off as “damaged beyond repair” in some way, then you are suddenly free to leave them and head off to find another less flawed human being.

Elspeth then emailed me and Scott about this.

I replied.

Mental Illness == psychiatric disorder. It is a euphemism. An old philosopher (Karl Jaspers) divided these into the psychoses (madness) and neuroses (anxiety and depression) and argued that the former were the realm of the psychiatrists.

And the older I get the more I think he was right.

The current diagnostic system exists to allow us to code conditions and get paid. It is over inclusive. In short, if your anxiety, addiction, or madnes is not ruining your life, making you suffer, then you are another one of the mass of humans. Who suffer, grieve, and are hurt.

It has never been a post modern world. That is false. The conditions are real.

On aetiology: no one knows. What we do know is that there are familial and genetic predispositions, they are polygenetic, (multiple genes), that environment matters particularly stress and abuse, and under those conditions you prune your neural networks in dysfunctional ways. Most of your brain volume is synapses (nerve junctions) and these are made and unmade continuously.

Yes, people do recover completely. The more mild conditions more frequently than the more severe: but a third of the people who have a psychotic break never have another.

Modern medicine and talking therapies resolve the symptoms of depression and anxiety equally well. But with the more severe conditions, they manage them.

For those, you need healing beyond medicine.

And Scott also replied.

There are several problems that are contributing to our operationalizing and understanding in a meaningful way what it means to be mentally ill.

First, as Chris points out, there needs to be a distinction between disorders that are of organic etiologies (like the entire classification of thought disorders, mental retardation, etc) and the vast array of maladaptive behaviors and coping mechanisms that make up personality pathology and all that is downstream from it.

On the one hand, you could argue from a factorial perspective, which I suspect most laypeople BELIEVE we do. And in some ways, it is true. This would be the closest thing to “science” that we use to classify these things. I don’t want to insult you, but factors just mean “clumps of symptoms that tend to hang together.” In very well established constructs like depression and PTSD, they do this with such predictive reliability, that we can say for certain that at least they exist. Put it this way. If I get 1000 patients who have all be legitimately diagnosed with depression, I can reasonable assume that about 800 of them have a typical presentation with sleep disturbances, low mood, low volition, cognitive symptoms, eating disturbances, anhedonia, loss of sex drive and in severe cases, suicidal thoughts. Not all disorders have such robust literature to support their existence at all. The DSM committees uses this method, SOMETIMES, and is supposed to be free of theoretical model jargon and politics. But not too long ago, homosexuality was a mental disorder, and it went away due to political correctness. In my opinion it is still disordered, if for no other reason than it is a sexual tendency that does not produce offspring.

Reality testing is another good measure. Psychotic patients literally do not live in this world with us. That’s a pretty good indication that their brain is broken.

But the biggest problem, and I have been writing about this for a while now, is the onslaught of subjectivity that we are swimming in today. The bedrock of any mental disorder is comparing it (even as a factorial construct) to socially normative standards. This is what is going to kill the profession and make it totally untenable in the future.

For if “otherkind” is just a totally appropriate lifestyle choice, we are doomed. I can no longer compare my subject/patient to a normative sample because there are no normative samples.

This creates a situation where the ONLY THING THAT MATTERS from an ethical perspective is what does the patient want? If the patient wants to soothe his or her conscience for something that Christians like Chris and I find abhorrent, who are we to judge? This is why, for example, it is extremely distressing for me when I am forced to see gay “married” couples in the army who wish to work on their “marriage” problems. (I cannot turn down patients in the army, it is against the rules). From my perspective, their biggest problem is that they are shitting on the sacrament of marriage every day and they should be struck dead by a lightening bolt, or repent.

The mental health profession has shot itself in the foot by worshipping at the altar of diversity and inclusiveness. We made ourselves the secular clergy, and replaced the word “sin” with “inappropriate” and then declared everything under the sun “appropriate.”

All sin is not a mental disorder. Mental disorders exist because sin is in the world.

I agree with Scott about personality disorders (and I like the proposed ICD-11 classification: normal, personality dysfunction, personality disorder: with the criteria being can you function), not are you happy and perfect.

Scott is a psychologist: he deals more with personality, anxiety and mood disorders. But I’m a jobbing psychiatrist, on holiday. At work, I deal with mood disorders and psychosis plus personality disorders. I see comorbid anxiety disorders and substance abuse. The people we see do move our perspectives.

But this I am sure of: madness occurred because of the fall, for it is an illness. And we make habits, which can ruin us.

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One thought on “Mail: what is mental disorder?”

I am an admirer of Edward Shorter’s work – and I recently read How Everyone Became Depressed, which is a very convincing rehabilitation of ‘Nervousness’ and The Nervous Breakdown’ (‘Neuroses’) as general categories of non-psychotic psychiatric disorders.